… and other ways the medical field is skewed against women. It needs to change.

In a previous blog I spoke about how female complaints of pain are really not taken seriously, still, now! I have rarely been to a doctors appointment prior to my diagnosis without the insinuation it’s “just period-related” when there doesn’t seem to be an obvious answer – as if that’s something we should just put up with too!! But something else I saw doing the rounds lately was that disc herniation is more common in men, and it just didn’t sound right so I tried to investigate the source of this “fact” and found nothing! So I turned to the brilliant physios of Twitter to ask, and it seems I was right. It’s TOTAL BS!! I have no idea where this may have come from so if you have been told this during your training or read it in a text book, do let me know so we can correct it and stop misinformation circulating unquestioned. To quote my reliable source: “To suggest a mechanical degenerative process in a spinal disc is dependent on sex is unfounded. Think the “we” who told you this may not be trustworthy.”

So I then started thinking about all the other ways women are short changed and it’s really quite shocking how everything is still based around the “average MAN”. (I’d like not to get into a debate on gender here so for the purposes of the blog I’m using man/woman as just birth genders based on chromosomes). 

Perhaps when physio text books were first written, therapists were told that disc herniation was caused by repeated heavy lifting (it’s not) and back in the dark ages it was more likely that men did the manual jobs and our understanding of the spine was limited. Maybe, I thought, maybe this is the thought process. If that’s the case then it’s not only wrong but now obviously grossly outdated AND still just states a “fact” without context! Saying ‘something is more common in men’ implies that it is someone to do with sex that predisposes you to that thing rather than a set of environmental risk factors. You may well, therefore, have clinicians dismissing women’s back pain (as has happened to me with AS) because it would be too unusual for a woman to have this issue. So that makes it not only wrong but dangerous.

  • In my 8-year+ journey for the Ankylosing Spondylitis diagnosis I am constantly fighting the premise that it’s more common in men. Even today the statistics state that rather than the previously thought ratio of 10:1, we are closer to 3:1 male to female incidence. But I truly believe that even this is grossly exaggerated because of the differences in symptoms men and women present, different reaction to medications and the fact women are still always grossly under represented in the studies! HOW can you get an accurate picture of anything if you don’t have a 50/50 test population? I believe there are a huge number more women being ignored because they don’t have the classic fusion but more inflammation and radiographic symptoms which are more difficult to see on imaging and of course, women are less likely to be believed about severity of pain in the first place! To back up my thoughts, the Swiss Institute of ankylosing spondylitis have the ratio at 1.03:1 by the end of 2016. {great paper on this here}
  • The dosages of drugs are based on the size of an “average” man. All the instruction leaflets advise is the recommendation between child and adult – so the pre-filled tablets or syringes are supposed to suit someone like my 6’, 78kg partner and my 5’7” 56kg frame! Apparently I need to just take the recommended dose and no one EVER thinks to mention it may need adjusting, let alone the hormonal, genetic and environmental factors which all effect the way drugs behave in our bodies.
  • When it comes to health and safety, crash test dummies are man-sized. Even the vary rare European safety standards for cars that do include smaller dummies, they are placed in the passenger seat, meaning women drivers are often more severely injured in RTAs because of the untested driving position. To be clear: she is 47% more likely to be seriously injured, and 71% more likely to be moderately injured, even when researchers control for factors such as height, weight, seatbelt usage, and crash intensity. She is also 17% more likely to die. And it’s all to do with how the car is designed – and for whom.
  • Shall we get started on the number of women damaged or dying in child-birth because they are not listened to? Then forgotten about with the following physical and mental trauma which they are just expected to put up with. Shove an incontenance pad down there and shut up?! I’ve also spoken about this a lot previously and look forward to another postnatal training coming up where I will be supporting a new group of Yoga teachers in their learning about postnatal bodies and the joys of baby massage for bonding which can really help those who have had difficult birthing experiences.

On a broader level, I saw an article this week about female athletes speaking out on the abuse they suffer and the cat calls that ensue if you dare to go for a run. The article was peppered with men chiming in “how could a passing comment or whistle make you feel unsafe”? Errrrrr I don’t know, MANSPLAIN it to me why don’t you? Tell me how YOU are afraid that if you don’t smile back or if you do then it will end in being brutally attacked if you can’t run fast enough, coz that’s the raw truth. Instead of telling women to change our behaviour, how about you have a word with the lads and tell them them that calling after women MAKES US FEAR FOR OUR LIVES!! Men may be afraid of being rejected, women are afraid of being murdered so do not talk to me about how I should just ignore it and it shouldn’t bother me!

Back to medicine; there is an excellent article from The Guardian HERE, an excerpt from a whole book about this subject. It highlights the often appauling treatment of women with endometriosis and the fact that in general not enough women are included in clinical trials! Even in zoology, there is male bias to mammal studies and it took until 2016 that the issue was recognised and now female mammals must be included. Yet historically there have been numerous brutal medical experiments inflicted on women, so are we just good enough to experiment on but not interesting enough to study?

Another interesting blog in the BMJ talks about medical text books and how there is the male doctor fully dressed examining a semi-naked female patient. Never the other way round! There was also a great uproar about a hugely racist piece in a modern nursing text book which has now been withdrawn, but it stated that black people are more likely to ask for pain medication and believe in witchcraft! No wonder the number of black women suffering in child birth is much higher than other demographics!

Now, before I go on all week because there is SO much more to this subject than I can cover here, I’m obviously not trying to infer that issues around misdiagnosis and discrimination is only a female/gender-based issue. I know men suffer in different ways and no-one deserves to be ignored or their concerns dismissed, but we need a level playing field to begin with to even have a fighting chance. Study people equally. It can’t be that hard!!

NB: I’d like to thank Physio Jack and Mike Dare for answering my questions about some of this on Twitter with a willingness to help my enquiry and without even a hint of condescension.